Non-payment of claim for reimbursement of medical expenses

My company have a Mediclaim policy of reliance for all staff that was the biggest mistake in all staff have made in our life I am insured with reliance health wise health insurance plan since 31 dec.year 2008.I had deposited a claim on 10.12.2009 of Rs.15,272/- for reimbursement of expenses occurred on post hospitalization treatment of dengue (viral fever with vomiting) . After, some days when I contacted TPA(Medi Assist India) on phone it was informed to me that my claim has been approved by them, they asked for few additional papers after that , I have submitted all the required documents again ,

however, it has been sent to Reliance General Insurance Company ltd. for further approval . On contacting the latter, it was told to me that my case is under investigation. . It is pertinent to mention that an official on behalf of company had met me for instigation purpose 1 months back
On 15.01.2010, again contacting TPA , it was told to me that my case is under process for check preparation time required one week but one week not come in two months then I also got a complaint registered on company's helpline regarding delay in payment of claim amount. It was registered at No.1083974 sent a notice to Reliance General Insurance Company and TPA to make payment against my claim within 7days. No response/reply has been received. once again complaint registered on company's helpline regarding delay in payment of claim amount. It was registered at No.1083974 and tpa claim ref. no. 4564229.
then tpa wrote given attached scan copy . It is therefore request to take action against Reliance General Insurance Company and Medi Assist, as they connived to withhold my claim for more than 4 months. And now he write us i amm fraudial and i think he challenge me and our doctor.



Here people was fighting to get his claim settle and they don't even ready to support him. Really I am pained not due to medical treatment but for the troubles I am facing to lodge my complaint.

How can we trust private insurance companies?

Some one sold the policy to me. Now I am requesting lic enterprises also do the same?

If so what is the use for the insurance policies?

I do not know English and I am almost an illiterate.

every body to help me to get my claim.


My Policy No. is 28510366313
Addresses:-
1) Medi Assist India Pvt. Ltd.(Delhi Office)
F-2, Kailash Plaza, H-252, Sant Nagar, Delhi.

my name - BRIJESH KUMAR SHUKLA
13A/10, SITE-2
LONI ROAD INDUSTRIAL AREA,
MOHAN NAGAR
GHAZIABAD

Respected sir, Date : 14.07.2010

Sub : Complaint against claim – TPA Medi Assist
playing game -Reg

My present ailment is not a pre-existing one and not a heredity

Dear sir,
I K. Srinivas working in JMC Projects (I) Ltd , was attacked by heart related breathing problem on 30.01.2010. At that time I was working in Chennai and immediately I was admitted in nearby Chettinad hospital and after primary treatment there they referred me to Dr. Narasimhan who is working in CARE hospitals Hyderabad and he is the top most person in India for my problem. I was undergone by several tests by Dr. Narasimhan and finally on 10.02.2010 he said that surgery is the one & ultimate solution for my case. He also suggested to go for surgery at the earliest. The surgery costs around 6.00 Lakhs as per hospital sources. Through my office I am having insurance for 1.00 Lakh only which I have not gone for it. Secondly I thought of my personnel health insurance ( Policy No : 1304/282510279782 ) which I have taken in the month of July 2008 . It is Reliance General Insurance ( Health wise policy ). Unfortunately my name was considered as Srinivas . U.K instead of Srinivas.K . Around 15th of February ' 2010 I gave an application in the Electronic city,Banglore Reliance Insurance office for changing of my name. Against my name changing I got confirmation in one week. I went to CARE Banjara hills, Hyderabad for surgery on 22.02.10 and admitted on 25.02.10 and got operated on 25.02.10 by them.
I have taken the policy in the month of July 2008 and its TPA is Medi Assist (I) Pvt. Ltd , Bang lore. Before my admission on24.02.10 I gave written application to avail the cashless facility through Hospital Insurance people but there is no response from TPA and I was discharged on 27.02.10 by paying the fee interms of cash by borrowing the huge amount from friends and relatives ( Rs.539265/-). My officer in Bang lore transferred me to Hyderabad keeping my ailment in view. I applied for medical reimbursement with all required original documents in Medi Assist office in Bang lore and against that I received acknowledgement also. All this happened in the month of March 2010. Later I shifted my family to Hyderabad and Joined in Hyderabad office on 18.03.2010. When I gave my claim application in Medi Assist office in Bang lore they said that if no reply comes before 15 days they gave a landline number to call back. I got my complaint number as 4839263 on 20.03.2010 noon. One month after applied, I called the Toll free number stating my complaint number, they replied me that it is under process as there is no response from given number ( Land Line ). Around 20.05.10 I once again called for my claim & I got reply as it is under process. For further enquires I got the numbers of Delhi office stating as the claim belongs to huge amount. From then I am calling Delhi office but the concerned person is not responding. Other persons are attending and replying that I am not the concerned but I will forward and but nothing was done. At last I contacted Dr. Jyothi of Delhi on 07.06.2010 and she said that the important original documents are not given so kindly produce those documents to close the issue at the earliest. The queries they have are :
1. Provide all original prenumbered payment receipts against final bill
2. Provide all past treatment papers regarding present complaints
3. Provide all past policy copy details
4. Provide certificate from treating doctor for confirm exact past history and cause of present ailment and provide first consultation papers when present ailment diagnosed for the first time.
5. Provide all investigation reports done during hospitalization regarding present complaint
6. Provide original hospital final bill
7. Provide CAG report
8. Provide sticker / invoice of implant
With out the above details is it possible to process the complaint ?
That means they simply killed valuable time and they purposefully does not want to reimburse the amount . It is useful for their excuse if I proceed legally, that we didn’t said we will not do reimbursement provided all original documents are fulfilled as per the requirement. It is simply to escape. If they really don’t want to reimburse they can go for specific cause after thorough enquiry. (1) . If I say with hospital that I need another set of my original bills from each and every hospital from the beginning of present ailment they will suspect me and they will not give. (2) . If I start procuring the said documents it will take a minimum of 3 to 4 months at least as I have to collect from different places.
My present ailment is not a pre-existing one and not a heridity
In between around 24.05.10 when I spoke with Delhi office they said that as the case is pertaining to Hyderabad the file is transferred to Hyderabad and immediately I contacted Hyderabad office they said that they have not received any such file . (I quoted my claim no. for reference.) To Bang lore office along with all requisite original documents for claim I submitted the Xerox copy my name change also. On 08.06.10 when I asked the Delhi office about the queries that I have submitted in Bang lore office they replied that in respect of Bang lore documents speak with them only and ask them to update them so that it will be updated in our system also. Since then I am trying to contact them but there is no response from Bang lore office. I request you to kindly do me the needful in this respect.
Conclusions of the case :
1 ) With out going through the documents I have submitted against claim they time passed by saying it is under process.
2 ) Not responding to phone calls
3 ) Giving wrong information that the case was transferred from Banglore to Delhi and Delhi to Hyderabad
If the TPA wants to make enquiry they can make but at the earliest as already time is being wasted by them.
Thanking you sir,
K. Srinivas Yours truly,
19-44/2, Flat no: 002,
Meghana Enclave,
Gowtham Nagar, K . Srinivas
Malkajgiri,
Hyderabad – 47
Mobile: 9014736012 : 8897334649

I have got a Medical Insurance policy through RELIANCE General Insurance Co. Ltd.
The details of my policy is as below:

MA-ID 4009801108
Name Mukhtar Ahmed Malik
Relation: Self
Policy Holder: One Touch Solutions India P Ltd.
PriBenef: Mukhtar Ahmed Malik
Emp No.: OTS270
Serviced by MEDI ASSIST INDIA TPA PVT LTD


I have got very bad experience with my insurance company. I had an emergency surgery 3 months ago in Rockland Hospital based in Katwaria Sarai New Delhi. The cost of my operation was more than 3 Lakh Rupees. I couldn't afford such amount that time then I owed money from my relatives. I was left with only one hope that my medical policy will help me financially, but I only got fake excuses from my Insurer.

I am helpless.
Is their someone who can guide me?
If you need further information about the same then mail me or you can also call me.
Email: jeff.beauty@gmail.com
Mobile: 91-7838116277

Thanks & Regards:
Mukhtar Ahmad Malik